Dehnen Alessia, Borchardt Benjamin, Schillen Philip, In der Schmitten Jürgen, Kersting Christine, Fuchs Angela, Chikhradze Nino, Dehnen Dorothea
Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
Lehrstuhl für Allgemeinmedizin II und Patientenorientierung in der Primärversorgung, Institut für Allgemeinmedizin und Ambulante Gesundheitsversorgung (iamag), Universität Witten/Herdecke, Witten, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2025 Feb;192:66-76. doi: 10.1016/j.zefq.2024.11.008. Epub 2024 Dec 31.
Strategies to counteract the impending and in some places already existing shortage of general practitioners (GPs) are being discussed in Germany. One approach could be to establish interprofessional teams in GP practices by integrating physician assistants (PAs).
Can GPs imagine employing a PA in their practice and if so, under what conditions?
In March/April 2023, about 5,000 GPs in North Rhine-Westphalia (NRW), who work in a region with a care level of < 100 %, and about 1,000 GPs from Saxony-Anhalt were asked to take part in an online-based survey. Simultaneously, semi-structured preliminary interviews (one online focus group with four participants, seven individual interviews) were conducted with GPs from NRW.
290 GPs participated in the survey (response rate approx. 5 %). Of these, 46.3 % expressed interest in employing a PA in their practice. A majority of 60 % considered assignments such as conducting an open consultation for uncomplicated respiratory tract infections or vaccination consultations to be delegable. As many as 21.9 % would be willing to pay a PA more than 3,500 euro gross monthly salary (based on a full-time position) (8.7 % more than 4,000 euro), while 38.4 % stated that they could not currently afford the cost of employing a PA. The qualitative results underline these findings. One of the respondents' conditions for the employment of a PA was to abolish the quarterly budget limits for GPs.
Many GPs already express their interest and willingness to both employ PAs and to delegate medical tasks to them - in spite of unanswered questions and, possibly, by necessity. About a fifth of the participants can even imagine paying from their own budget the same gross salary that PAs employed by hospitals are paid. Reliable clarification of feasibility, safety and cost-effectiveness of the use of PAs as well as effects on the quality of treatment in primary care should be a priority for health policy actors.
TAKE-HOME MESSAGE: From the GP's point of view, the integration of PAs into GP-centred care in terms of an interprofessional team practice has got potential. At the same time, the question of financial feasibility is still unsettled.
德国正在讨论应对即将出现以及在某些地方已经存在的全科医生短缺问题的策略。一种方法可能是通过整合医师助理（PA）在全科医生诊所中建立跨专业团队。
全科医生能否想象在其诊所雇佣一名医师助理？如果可以，在什么条件下？
2023年3月/4月，邀请了北莱茵-威斯特法伦州（NRW）约5000名在护理水平低于100%地区工作的全科医生以及萨克森-安哈尔特州的约1000名全科医生参与一项在线调查。同时，对来自NRW的全科医生进行了半结构化初步访谈（一个有四名参与者的在线焦点小组，七次个人访谈）。
290名全科医生参与了调查（回复率约为5%）。其中，46.3%表示有兴趣在其诊所雇佣一名医师助理。60%的大多数人认为诸如对简单呼吸道感染进行开放式咨询或疫苗接种咨询等任务是可以委托的。多达21.9%的人愿意为一名医师助理支付每月超过3500欧元的毛工资（基于全职岗位）（8.7%的人愿意支付超过4000欧元），而38.4%的人表示他们目前负担不起雇佣一名医师助理的费用。定性结果证实了这些发现。受访者雇佣医师助理的条件之一是取消对全科医生的季度预算限制。
尽管存在未解决的问题，而且可能是出于必要，许多全科医生已经表达了雇佣医师助理并将医疗任务委托给他们的兴趣和意愿。约五分之一的参与者甚至可以想象从自己的预算中支付与医院雇佣的医师助理相同的毛工资。可靠地阐明使用医师助理的可行性、安全性和成本效益以及对初级保健治疗质量的影响，应该是卫生政策制定者的首要任务。
从全科医生的角度来看，将医师助理纳入以全科医生为中心的跨专业团队护理有潜力。同时，财务可行性问题仍未解决。
